Kuvunika kw'akaguru ni bumwe mu bwoko bw'imvune zikunze kugaragara mu buvuzi. Uretse imvune zimwe na zimwe zo mu cyiciro cya mbere/icya kabiri zo kuzunguruka no gukomeretsa umuntu, imvune nyinshi zo ku kaguru akenshi ziba ku gice cyo ku ruhande. Kuvunika kw'akaguru ko mu ruhande rwa Weber A/B akenshi bitera indwara idakira ya tibiofibular syndesmosis kandi bishobora kugabanuka neza iyo umuntu abonye neza uhereye kure kugeza hafi. Mu buryo bunyuranye, kuvunika k'akaguru ko mu ruhande rwa C bitera kudahagarara neza kwa malleolus mu gice cyo ku ruhande mu bice bitatu bitewe n'imvune ya tibiofibular yo mu ruhande, bishobora gutera ubwoko butandatu bwo kwimuka: kugabanya/kwagura, kwaguka/kugabanya umwanya wa tibiofibular yo mu ruhande rwo ku ruhande, kwimuka imbere/inyuma mu gice cyo ku ruhande, kuzunguruka hagati/inyuma mu gice cyo ku ruhande, kwimuka kuzunguruka, no guhuza ubwo bwoko butanu bw'imvune.
Ubushakashatsi bwinshi bwakozwe mbere bwagaragaje ko kugabanya/kongera uburebure bishobora gusuzumwa binyuze mu gusuzuma ikimenyetso cya Dime, umurongo wa Stenton, n'inguni ya tibial-gapping, n'ibindi. Kwimuka mu miterere ya coronal na sagittal bishobora gusuzumwa neza hakoreshejwe uburyo bwo kureba imbere n'iruhande rw'inyuma bwa fluoroscopic; icyakora, kwimuka mu buryo bwo kuzunguruka ni byo bigoye cyane gusuzuma mu gihe cyo kubagwa.
Ingorane mu gusuzuma aho ingirabuzimafatizo zizenguruka zigaragara cyane cyane mu kugabanuka kwa fibula iyo ushyizemo screw ya tibiofibular iri kure. Inyandiko nyinshi zigaragaza ko nyuma yo gushyiramo screw ya tibiofibular iri kure, habaho kugabanuka gukabije kwa 25%-50%, bigatuma habaho malunion no gufungana kwa fibular. Hari intiti zatanze igitekerezo cyo gukoresha isuzuma rya CT risanzwe mu gihe cyo kubaga, ariko ibi bishobora kugorana kubishyira mu bikorwa. Kugira ngo iki kibazo gikemuke, mu 2019, itsinda rya Porofeseri Zhang Shimin wo mu bitaro bya Yangpu bikorana na Kaminuza ya Tongji ryasohoye inkuru mu kinyamakuru mpuzamahanga cy’ubuvuzi bw’amagufwa *Injury*, itanga igitekerezo cy’uburyo bwo gusuzuma niba lateral malleolus rotation yakosowe hakoreshejwe X-ray mu gihe cyo kubaga. Inyandiko zigaragaza ko ubu buryo bufite akamaro kanini mu buvuzi.
Ishingiro ry’ubu buryo ni uko mu buryo bwo kureba ku kaguru hakoreshejwe fluoroscope, igice cyo ku rukuta rw’inyuma cya fossa ya malleolar lateral kigaragaza igicucu gisobanutse neza, gihagaze, kandi cyuzuye, gihuye n’ibice byo hagati n’ibyo ku ruhande bya malleolus, kandi giherereye hagati kugeza kuri kimwe cya gatatu cy’umurongo uhuza ibice byo hagati n’ibyo ku ruhande bya malleolus lateral.
Ishusho y'ishusho ya fluoroscopic y'akaguru igaragaza isano iri hagati y'urukuta rw'inyuma rwa fossa ya malleolar (umurongo wa b) n'inyuma ya cortices ya medial n'inyuma ya malleolus (umurongo wa a na c). Ubusanzwe, umurongo wa b uba ku murongo wa gatatu w'inyuma hagati y'umurongo wa a na c.
Aho malleolus iherereye mu ruhande, aho izenguruka ry’inyuma, n’aho izenguruka imbere bishobora gutanga amashusho atandukanye mu ishusho ya fluoroscope:
- Malleolus yo mu ruhande rw'inyuma yazungurukaga mu buryo busanzwe**: Ishusho isanzwe ya malleolus yo mu ruhande rw'inyuma ifite igicucu cy'inyuma ku rukuta rw'inyuma rwa fossa ya malleolar yo mu ruhande rw'inyuma, ishyizwe ku murongo wa gatatu w'inyuma w'inyuma n'inyuma ya malleolus yo mu ruhande rw'inyuma.
-Ubusembwa bwo kuzenguruka inyuma kwa malleolus**: Ishusho ya malleolus yo ku ruhande isa n'aho "ifite amababi atyaye", igicucu cya cortical kuri fossa ya malleolar yo ku ruhande kirashira, umwanya wa tibiofibular uri kure uragabanuka, umurongo wa Shenton uracikagurika kandi ugatatana.
-Ubusembwa bw'imbere bwa malleolus**: Ishusho ya malleolus yo ku ruhande isa n'"ikiyiko", igicucu cya cortical kuri fossa ya malleolar yo ku ruhande kirashira, kandi umwanya wa tibiofibular uri kure uraguka.
Itsinda ryari rigizwe n'abarwayi 56 bafite imvune zo mu bwoko bwa C-type lateral malleolar fractures hamwe n'imvune zo mu gice cya tibiofibular syndesmosis, kandi bakoresheje uburyo bwo gusuzuma bwavuzwe haruguru. Isuzuma rya CT ryongeye gukorwa nyuma yo kubagwa ryagaragaje ko abarwayi 44 bagabanutseho imiterere y'umubiri wabo nta busembwa bwo kuzunguruka, mu gihe abarwayi 12 bahuye n'ubusembwa bwo kuzunguruka bworoheje (munsi ya 5°), hamwe n'abantu 7 bazunguruka imbere n'abantu 5 bazunguruka inyuma. Nta busembwa bwo kuzunguruka inyuma buri hagati (5-10°) cyangwa bukomeye (burenze 10°) bwabayeho.
Ubushakashatsi bwakozwe mbere bwagaragaje ko isuzuma ry’igabanuka ry’amagufwa yo mu ruhande rw’inyuma rishobora gushingira ku bipimo bitatu by’ingenzi bya Weber: uburinganire buri hagati y’ubuso bw’ingingo ya tibial na talar, gukomeza k’umurongo wa Shenton, n’ikimenyetso cya Dime.
Kugabanya nabi imiterere y'ingingo zo mu ruhande rw'umubiri ni ikibazo gikunze kugaragara mu buvuzi. Nubwo kwita ku gusubirana uburebure, hakwiye gushyirwaho agaciro gakomeye ku gukosora imiterere y'ingingo. Nk'ingingo itwara ibiro, kugabanya uburemere bw'ingingo zo mu ruhande rw'umubiri bishobora kugira ingaruka mbi ku mikorere yayo. Bikekwa ko uburyo bwo gupima imiterere y'ingingo zo mu ruhande rw'umubiri mu gihe cyo kubaga bwatanzwe na Porofeseri Zhang Shimin bushobora gufasha mu kugabanya neza imvune zo mu ruhande rw'umubiri zo mu bwoko bwa C. Ubu buryo ni ingenzi ku baganga b'imbere.
Igihe cyo kohereza: Gicurasi-06-2024
